Publications by authors named "Kharawala A"

Introduction: Nonbacterial thrombotic endocarditis (NBTE) involves vegetations on heart valves without active bloodstream infection. The AngioVac device, a vacuum-based aspiration system commonly used for infective endocarditis, has potential in managing NBTE, particularly in patients unsuitable for surgery. This study systematically reviews the literature to evaluate AngioVac's effectiveness in reducing vegetations in NBTE.

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Introduction: Inclisiran is a novel drug that employs ribonucleic acid (RNA) interference to lower the levels of the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein. It has demonstrated a significant reduction in LDL cholesterol levels compared to a placebo. We aim to comprehensively evaluate the safety of using Inclisiran in patients with dyslipidemia and ASCVD or an ASCVD risk equivalent.

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Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades.

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Article Synopsis
  • - Acute recurrent myopericarditis is a rare condition that occurs after a symptom-free period of 4-6 weeks, with no clear management guidelines, making it difficult to understand its causes and treatment.
  • - A case study of a 44-year-old man showed he had recurrent myopericarditis caused by Coxsackie A virus, diagnosed through elevated biomarkers and pericardial effusion, and he improved with colchicine and ibuprofen.
  • - The recurrence of myopericarditis can happen in 15%-50% of cases and is linked to various factors, but using current treatment methods for recurrent pericarditis has led to significant symptom relief, highlighting the need for more research into
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Atrial and ventricular arrhythmias are common in patients with Infiltrative heart diseases. This review discusses ablative techniques for arrhythmias in amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders, primarily focusing on atrial fibrillation (AF). A thorough literature review was conducted on the MEDLINE database to synthesize current knowledge and propose future research directions.

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Article Synopsis
  • - Embolic protection devices (EPDs) are used during percutaneous coronary interventions (PCI) to catch debris that can cause complications; this study focused on their effectiveness and safety in ST-elevation myocardial infarction (STEMI) patients without saphenous vein grafts (SVG).
  • - Researchers analyzed data from three randomized controlled trials (RCTs) involving 741 patients, examining multiple outcomes including 30-day mortality and major adverse events following PCI with and without EPDs.
  • - Results showed that while EPDs did not significantly affect overall mortality or other major outcomes like heart flow and ST segment resolution, they did significantly lower the incidence of detectable distal embolization.
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Chronic thromboembolic pulmonary hypertension (CTEPH) is an underdiagnosed sequela of acute pulmonary embolism with varied clinical presentation causing significant morbidity among the affected population. There exist important differences in the occurrence, clinical features and diagnosis of CTEPH between men and women, with women carrying a greater predisposition for the disease. Ongoing studies have also pointed out variations among men and women, in the treatment offered and long-term outcomes including mortality.

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Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called "obesity paradox"-a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts-merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications.

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Orthotopic heart transplant is the gold standard therapeutic intervention for patients with end-stage heart failure. Conventionally, heart transplant has relied on donation after brain death for organ recovery. Donation after circulatory death (DCD) is the donation of the heart after confirming that circulatory function has irreversibly ceased.

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Background: Masses in the heart and valves have a broad differential diagnosis including infective and rheumatic causes as well as primary or metastatic tumours. Diagnosis involves delineating the location, shape, and origin of the mass/masses and considering the clinical context. This case outlines the work-up and approach to diagnosing a cardiac mass along with imaging findings of a unique secondary metastatic mass in the left ventricle (LV).

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Lower extremity peripheral artery disease (PAD) affects over 230 million adults globally, with hypertension being one of the major risk factors for the development of PAD. Despite the high prevalence, patients with hypertension who have concomitant PAD are less likely to receive adequate therapy. Through this review, we present the current evidence underlying hypertension management in PAD, guideline-directed therapies, and areas pending further investigation.

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Background: Despite its clinical benefits, patient compliance to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) varies and remains under-studied in diverse populations.

Objective: We sought to evaluate RM compliance, clinical outcomes, and identify demographic and socioeconomic factors affecting RM in a diverse urban population in New York.

Methods: This retrospective cohort study included patients enrolled in CIED RM at Montefiore Medical Center between December 2017 and May 2022.

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Article Synopsis
  • - The study investigates characteristics that affect successful revascularization in patients with lower extremity chronic total occlusions (CTOs) compared to those with non-CTO stenosis, revealing significant demographic and clinical differences.
  • - Among the 256 patients analyzed, those with CTOs showed a higher prevalence of risk factors such as myocardial infarction and end-stage renal disease, while aspirin use predicted better outcomes and a history of malignancy predicted worse outcomes for crossing CTOs.
  • - Findings suggest that successful endovascular revascularization is linked to specific baseline clinical variables and the overall health burden in CTO patients, highlighting the complexity of their condition.
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New-onset or worsening tricuspid regurgitation (TR) is a well-established complication encountered after cardiac implantable electronic devices (CIEDs). However, there are limited and conflicting data on the true incidence and prognostic implications of this complication. This study aimed to bridge this current gap in the literature.

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Aims: Since their introduction in 1958, traditional cardiac pacemakers have undergone considerable upgrades over the years, but they continue to have a complication rate of ∼3.8%-12.4%.

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Nonbacterial thrombotic endocarditis (NBTE) is a distinctive condition marked by the presence of aseptic fibrin depositions on cardiac valves due to hypercoagulability and endocardial damage. There is a scarcity of large cohort studies clarifying factors associated with morbidity and mortality of this condition. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve case reports and series documenting cases of NBTE from inception until September-2022.

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Key Clinical Message: Mitral valve aneurysm is a rare imaging finding most caused by infective endocarditis. The concurrent presence of an aortic valve aneurysm is unique and foretells a severe presentation that would require valve replacement during the same admission.

Abstract: A 42-year-old male patient presented with intermittent fever, night sweats, and weight loss for 2 months.

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Introduction: A significant increase in the use of computed tomography with pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) has been observed in the past twenty years. We aimed to investigate whether the validated diagnostic predictive tools and D-dimers were adequately utilized in a large public hospital in New York City.

Methods: We conducted a retrospective review of patients who underwent CTPA for the specific indication of ruling out PE over a period of one year.

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Objective: The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic brain lesions among otherwise healthy divers.

Background: Next to drowning, NDCS is the most severe phenotype of diving-related disease and may cause permanent damage to the brain and spinal cord. Several observational reports have described the presence of an RLS as a significant risk factor for neurological complications in divers, ranging from asymptomatic brain lesions to NDCS.

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• Ascending TAA tend to be asymptomatic and are not rare, even in young individuals. • Consider Marfan, Ehlers Danlos, Loeys-Dietz, Turner, bicuspid aortic valve, or tertiary syphilis. • Familial thoracic aortic syndrome is a rare autosomal dominant cause.

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Background: New onset Systolic heart failure (SHF), characterized by new onset left ventricular (LV) systolic dysfunction with a reduction in ejection fraction (EF) of <40%, is a common cause of morbidity and mortality among Orthotopic liver transplant (OLT) recipients. Therefore, we aimed to evaluate the prevalence, the pre-transplant predictors, and the prognostic impact of SHF post-OLT.

Methods: We conducted a systematic review of the literature using electronic databases MEDLINE, Web of Science, and Embase for studies reporting acute systolic heart failure post-liver transplant from inception to August 2021.

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Background: Ethnic and sex-based disparity in outcomes after out-of-hospital cardiac arrest (OHCA) may exist and could be due to social factors and inequality in care. We aimed to study whether ethnic and sex-based differences in out-of-hospital cardiac arrest outcomes occurred in a safety net hospital within the largest municipal healthcare system in the United States.

Methods: We conducted a retrospective cohort study of patients successfully resuscitated from an OHCA and brought to New York City Health + Hospitals/Jacobi, from January 2019 to September 2021.

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Aim: The aim of this article is to estimate prevalence of menopausal symptoms among women in the menopausal age group and study the urban-rural differences.

Methods And Design: Analytical cross-sectional study conducted in rural and urban field practice areas of a tertiary care center affiliated to Medical College, where 290 women (145 each from urban and rural areas) were interviewed to measure prevalence of menopausal symptoms. Forty-one symptoms were divided into 'Psycho-somatic' (17 symptoms), 'genito-urinary (9 symptoms)' and musculo-skeletal (5 symptoms) domains.

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Background: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI).

Methods: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups.

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